• Home Health Quality Assurance Manager

    Kindred at HomeAtlanta, GA

    Job #512184088

  • I believe that better care begins at home.
    Compassionate care, uncompromising service and clinical excellence - that's what our patients have come to expect from our clinicians. Kindred at Home, a division of Kindred Healthcare Inc., is the nation's leading provider of comprehensive home health, hospice, and non-medical home care services.

    Kindred at Home, and its affiliates, including Gentiva, delivers compassionate, high-quality care to patients and clients in their homes or places of residence, including non-medical personal assistance, skilled nursing and rehabilitation and hospice and palliative care. Our caregivers focus on each unique patient to deliver the appropriate care and emotional support to our patients and their families.

    I believe my work is my calling.

    As a Home Health Quality Assurance RN Manager, you will:
      • Review all Medicare and other episodic payers' clinical records at the local level to assure appropriate documentation for reimbursement. This review includes verification of appropriate documentation, quality of care provided, visits utilization, appropriate contacts with physicians, adherence to the care plan, and evidence of communication between disciplines. • Oversee the maintenance of clinical records and files to comply with Conditions of Participation (COPs), using measurements, as licensure, certification, and accreditation results. • Audit charts for clinical oversight and compliance and adherence to the Medicare guidelines. • Identify clinical problem areas and document deficiency trends in a proactive approach. Educate administrative and clinical associate staff in the correction of these deficiencies. • Assist with quality improvement and Medicare compliance training program. Utilize Gentiva Health Services approved reference materials to resolve inadequacies. • Communicate with the Area Education Specialist regarding identified trends of deficiencies with Medicare Conditions of Participation, clinical care, coordination of care, and documentation for the purposes of requiring more extensive education or action of clinical staff. • In accordance with the Branch Director, monitor the receipt of Medicare denials, Billing Compliance held claims, and other payer denial notices. Assess the validity of these denials, and respond with additional information. Inform the Branch Director and Branch staff of noticeable trends or relevant issues. • In accordance with the Branch Director, prepare and file general appeals on a timely basis. Attend fair hearings as necessary. • Collaborate with the Clinical Leadership and clinical associate staff in resolving complex clinical issues. • Participate in the initial orientation of the clinical associate staff regarding Medicare Conditions of Participation and relevant requirements for care and documentation and provide education during the orientation in the timeliness of paperwork and flow of OASIS. • Collaborate with branch Clinical Leadership to analyze Performance Improvement trends in the delivery of care. Keep up with the performance indicators and monitor the Performance Improvement plan for the branch. Essential in driving performance measures in the branch. • Review OASIS documents for accuracy and completeness prior to locking and submitting data electronically. Explain and mentor clinicians and staff on COP's and on billable skilled visits. • Educate and mentor clinicians one on one (in person or over the phone) regarding concerns, questions, accuracy of OASIS data, and other related documents, that are being reviewed. • Facilitate the ICD-9/10 coding of the Plan of Treatment based on OASIS data and patient assessment documentation that is assessed at the bedside. • Collaborate with branch leadership to ensure effective and efficient episodic management, utilizing Gentiva Health Services reports such as Projected vs. Actual, PPS Unbilled and Post Billing Adjustment, to identify trends.

    Required Skills

    Qualifications:
      • Bachelor's degree in Nursing or the equivalent • Minimum of three to five years nursing experience, including two years of home healthcare experience within the past five years • Prior ICD-9/10 coding experience • R.N. License • Working knowledge of Medicare home health requirements • Analytically inclined and detailed oriented to ensure proper and accurate coding for reimbursement

    Required Experience

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    ~MON~

    All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or national origin.

    Job Location Atlanta, Georgia, United States Position Type Full-Time/Regular

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    Updated 10/16/2017

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